PROJECT SUMMARY There is a high incidence of tobacco use among patients with cancer. Many are unable to quit smoking before surgery, and relapse rates are high among those who are able to abstain after the initial cancer diagnosis. Tobacco use is linked to serious complications with treatment, including increased problems with wound healing after surgery. Contingency management, a behavioral intervention in which abstinence is reinforced (typically with monetary incentives), has shown promise as an intervention for smoking. In our preliminary work, we designed a contingency management protocol for pre-surgical cancer patients. A pilot study was conducted to generate an effect size for smoking cessation at the time of surgery (7-day point prevalence abstinence), and a secondary aim of creating an effect size for long-term abstinence at 3 months post-surgery. Patients (N=40) were randomized to receive either: Standard Care + Monitoring (SC; i.e., 3-6 counseling sessions + nicotine replacement therapy [NRT] + monitoring breath CO 3 times per week with no contingencies; N=19) or CM (i.e., 3-6 counseling sessions + NRT + monetary payment delivered contingent on a negative breath CO; N=21). In the CM group 52% (11/21) of the patients were abstinent for 7 days prior to surgery compared to 16% (3/19) of the patients in SC (adjusted RR=3.3, CI: 1.1-9.7, p=0.03). At the 3-month follow-up, 43% (9/21) of CM patients remained abstinent compared to 5% (1/19) in the SC group (adjusted RR=8.6, CI: 1.5-49.4, p=0.02). For the present study, we propose a powered, large scale (N=282) smoking cessation clinical trial to test a CM intervention for cancer patients. The intervention will mirror our prior work, focusing on patients who are undergoing surgery for their cancer. No studies have evaluated a CM intervention with smokers who have a life-threatening illness. However, our pilot data with pre-surgical cancer patients who smoke has shown that this may be a promising intervention with cancer patients. We hypothesize that this highly effective treatment, by promoting high rates of smoking cessation, will also be associated with better surgical outcomes. Interventions for smoking cessation prior to cancer surgery are understudied and a valuable tool in promoting improved surgical outcomes.